Determinants of household catastrophic costs for drug sensitive tuberculosis patients in Kenya

Abstract Background Despite free diagnosis and treatment for tuberculosis (TB), the costs during treatment impose a significant financial burden on patients and their households. The study sought to identify the determinants for catastrophic costs among patients with drug-sensitive TB (DSTB) and their households in Kenya. Methods The data was collected during the 2017 Kenya national patient cost survey from a nationally representative sample (n = 1071). Treatment related costs and productivity losses were estimated. Total costs exceeding 20% of household income were defined as catastrophic and used as the outcome. Multivariable Poisson regression analysis was performed to measure the association between selected individual, household and disease characteristics and occurrence of catastrophic costs. A deterministic sensitivity analysis was carried using different thresholds and the significant predictors were explored. Results The proportion of catastrophic costs among DSTB patients was 27% (n = 294). Patients with catastrophic costs had higher median productivity losses, 39 h [interquartile range (IQR): 20–104], and total median costs of USD 567 (IQR: 299–1144). The incidence of catastrophic costs had a dose response with household expenditure. The poorest quintile was 6.2 times [95% confidence intervals (CI): 4.0–9.7] more likely to incur catastrophic costs compared to the richest. The prevalence of catastrophic costs decreased with increasing household expenditure quintiles (proportion of catastrophic costs: 59.7%, 32.9%, 23.6%, 15.9%, and 9.5%) from the lowest quintile (Q1) to the highest quintile (Q5). Other determinants included hospitalization: prevalence ratio (PR) = 2.8 (95% CI: 1.8–4.5) and delayed treatment: PR = 1.5 (95% CI: 1.3–1.7). Protective factors included receiving care at a public health facility: PR = 0.8 (95% CI: 0.6–1.0), and a higher body mass index (BMI): PR = 0.97 (95% CI: 0.96–0.98). Pre TB expenditure, hospitalization and BMI were significant predictors in all sensitivity analysis scenarios. Conclusions There are significant inequities in the occurrence of catastrophic costs. Social protection interventions in addition to existing medical and public health interventions are important to implement for patients most at risk of incurring catastrophic costs. Graphic abstract

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Determinants of Household Catastrophic Costs for Drug Sensitive Tuberculosis Patients in Kenya

10.21203/rs.3.rs-135057/v1 ◽

2020 ◽

Author(s):

Beatrice Wangari Kirubi ◽

Jane Ong’ang’o ◽

Peter Nguhiu ◽

Knut Lönnroth ◽

Aiban Rono ◽

...

Keyword(s):

Public Health ◽

Sensitivity Analysis ◽

Social Protection ◽

Financial Burden ◽

Public Health Facility ◽

Household Expenditure ◽

Delayed Treatment ◽

Productivity Losses ◽

National Patient ◽

Nationally Representative

Abstract Background: Despite free diagnosis and treatment for Tuberculosis (TB), the costs during treatment impose a significant financial burden on patients and their households.Aim: The study sought to identify the determinants for catastrophic costs among patients with drug-sensitive TB (DSTB) and their households in Kenya.Methods: The data was collected during the 2017 Kenya national patient cost survey from a nationally representative sample (n=1071). Treatment related costs and productivity losses were estimated. Total costs exceeding 20% of household income were defined as catastrophic and used as the outcome. Multivariable Poisson regression analysis was performed to measure the association between selected individual, household and disease characteristics and occurrence of catastrophic costs. A deterministic sensitivity analysis was carried using different thresholds and the significant predictors were explored.Results: The proportion of catastrophic costs among DSTB patients was 27% (n=294). Patients with catastrophic costs had higher median productivity losses, 39 hours interquartile range (IQR) 20-104, and total median costs of USD 567 (IQR 299-1,144). The incidence of catastrophic costs had a dose response with household expenditure. The poorest quintile was 6.2 times (95% CI 4.0-9.7) more likely to incur catastrophic costs compared to the richest. The prevalence of catastrophic costs decreased with increasing household expenditure quintiles (proportion of catastrophic costs: 59.7%, 32.9%, 23.6%, 15.9%, and 9.5%) from the lowest quintile (Q1) to the highest quintile (Q5). Other determinants included hospitalization: PR=2.8, (95% CI 1.8-4.5) and delayed treatment: PR=1.5 (95% CI 1.3-1.7). Protective factors included receiving care at a public health facility: PR= 0.8 (95% CI 0.6-1.0), and a higher Body Mass Index (BMI): PR= 0.97 (95% CI 0.96-0.98). Pre TB expenditure, hospitalization and BMI were significant predictors in all sensitivity analysis scenarios.Conclusion: There are significant inequities in the occurrence of catastrophic costs. Social protection interventions in addition to existing medical and public health interventions are important to implement for patients most at risk of incurring catastrophic costs.

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Household Expenditures And Direct Medical Costs Among Older Adults In Ghana: Evidence From Who-sage Wave 2

10.21203/rs.3.rs-18835/v1 ◽

2020 ◽

Author(s):

Paa-Kwesi Blankson ◽

Sandra Ama Hewlett ◽

Thomas Akuetteh Ndanu ◽

Gyaami Amoah ◽

Matthew Owusu Boamah ◽

...

Keyword(s):

Older Adults ◽

Social Protection ◽

Financial Burden ◽

World Health ◽

Household Expenditure ◽

Adult Health ◽

Health Coverage ◽

Financial Risk Protection ◽

Younger Adults ◽

Household Expenditures

Abstract Background: The Ghanaian population aged 60 years and older will almost double to reach 10% of the total population by 2050. Ascertaining the pattern of health expenditures among this growing population group is important to inform policy makers about the targets for financial risk protection as part of achieving Universal Health Coverage (UHC) by 2030. This study aimed to estimate household expenditures among older adults and determine the direct medical costs.Methods : The World Health Organization's Study on global AGEing and adult health (SAGE) Wave 2 was conducted in China, Ghana, India, Mexico, Russian Federation, and South Africa between 2014 and 2015, as a follow-up to Wave 0 in 2003 to 2004 and Wave 1 in 2007 to 2010. Survey questions explored sources of income and total direct expenditures in the year preceding interview. SAGE Ghana was implemented using face-to-face interviews in a nationally representative sample of persons aged 50+ years with a comparison sample of younger adults aged 18–49 years.Findings : Analyses included a total of 4,735 participants, with 1,948 (41.1%) males and 2,787 (58.9%) females, of median and mean ages of 58 years and 57.6 (±16.7), respectively. The average annual household expenditures were US$ 1,893.44 (±3,501.14). Older adults had higher expenditure levels at US$ 1,902 (± 3,876), as compared to younger adults, US$ 1,867 (±1,937). Direct health-related costs and food expenditure accounted for 18% and 46% respectively of the total household expenditure of older Ghanaian adults. The prevalence of catastrophic health expenditure among older adults in Ghana was 4.5% (95% CI 3.5% to 5.8%)Conclusion: These updated estimates on household expenditure among older adults provide needed evidence to support the inclusion of social protection mechanisms in the national ageing agenda. The National Health Insurance as presently did not reduce the financial burden for households with older adults.

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Examining Recent Trends in the Racial Disparity Gap in Tap Water Consumption: NHANES 2011–2018

Public Health Nutrition ◽

10.1017/s1368980021002603 ◽

2021 ◽

pp. 1-20

Author(s):

Asher Y. Rosinger ◽

Anisha I. Patel ◽

Francesca Weaks

Keyword(s):

Water Consumption ◽

Tap Water ◽

Ethnic Disparities ◽

Prevalence Ratio ◽

Bottled Water ◽

Water Crisis ◽

Cross Sectional ◽

The Us ◽

Recent Trends ◽

Nationally Representative

Abstract Objective As tap water distrust has grown in the US with greater levels among Black and Hispanic households, we aimed to examine recent trends in not drinking tap water including the period covering the US Flint Water Crisis and racial/ethnic disparities in these trends. Design Cross-sectional analysis. We used log-binomial regressions and marginal predicted probabilities examined US nationally-representative trends in tap and bottled water consumption overall and by race/ethnicity. Setting The National Health and Nutrition Examination Survey data, 2011–2018. Participants Nationally-representative sample of 9,439 children aged 2-19 and 17,268 adults. Results Among US children and adults, respectively, in 2017-2018 there was a 63% (adjusted prevalence ratio [PR]:1.63, 95%CI: 1.25-2.12, p<0.001) and 40% (PR:1.40, 95%CI: 1.16-1.69, p=0.001) higher prevalence of not drinking tap water compared to 2013-2014 (pre-Flint Water Crisis). For Black children and adults, the probability of not drinking tap water increased significantly from 18.1% (95%CI: 13.4-22.8) and 24.6% (95%CI: 20.7-28.4) in 2013–14 to 29.3% (95%CI: 23.5-35.1) and 34.5% (95%CI: 29.4-39.6) in 2017–2018. Among Hispanic children and adults, not drinking tap water increased significantly from 24.5% (95%CI: 19.4-29.6) and 27.1% (95%CI: 23.0-31.2) in 2013-14 to 39.7% (95%CI: 32.7-46.8) and 38.1% (95%CI: 33.0-43.1) in 2017-2018. No significant increases were observed among Asian or white persons between 2013-14 and 2017-18. Similar trends were found in bottled water consumption. Conclusions This study found persistent disparities in the tap water consumption gap from 2011–2018. Black and Hispanics’ probability of not drinking tap water increased following the Flint Water Crisis.

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Prevalence, pattern and determinants of chronic disease multimorbidity in Nepal: secondary analysis of a national survey

BMJ Open ◽

10.1136/bmjopen-2020-047665 ◽

2021 ◽

Vol 11 (7) ◽

pp. e047665

Author(s):

Raja Ram Dhungana ◽

Khem Bahadur Karki ◽

Bihungum Bista ◽

Achyut Raj Pandey ◽

Meghnath Dhimal ◽

...

Keyword(s):

Urban Areas ◽

Formal Education ◽

Secondary Analysis ◽

Density Lipoprotein ◽

Prevalence Ratio ◽

Urban Setting ◽

Chronic Obstructive ◽

Cluster Sampling ◽

Obstructive Pulmonary Disease ◽

Nationally Representative

ObjectivesTo assess the prevalence, pattern and determinants of non-communicable diseases (NCDs) multimorbidity in Nepal.DesignSecondary analysis of the data from the NCD survey 2018, which was conducted between 2016 and 2018.SettingThe data belong to the nationally representative survey, that selected the study samples from throughout Nepal using multistage cluster sampling.Participants8931 participants aged 20 years and older were included in the study.Primary outcomesNCD multimorbidity (occurrence of two or more chronic conditions including hypertension, diabetes, chronic obstructive pulmonary disease, chronic kidney disease, coronary artery disease and cancer). Descriptive statistics, prevalence ratio and odds ratio were computed to assess pattern and determinants of multimorbidity.ResultsMean (SD) age was 46.7 years (14.9 years). The majority of the participants were women (57.8%), without formal education (53.4%) and from urban areas (51.5%). Multimorbidity was present in 13.96% (95% CI: 12.9% to 15.1%). Hypertension and diabetes coexisted in 5.7%. Age, alcohol consumption, body mass index, non-high-density lipoprotein (non-HDL) level and rural–urban setting were significantly associated with multimorbidity.ConclusionMultimorbidity was prevalent in particular groups or geographical areas in Nepal suggesting a need for coordinated and integrated NCD care approach for the management of multiplicative co-comorbid conditions.

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Barriers to uptake of reproductive information and contraceptives in rural Tanzania: an intersectionality informed qualitative enquiry

BMJ Open ◽

10.1136/bmjopen-2019-036600 ◽

2020 ◽

Vol 10 (10) ◽

pp. e036600

Author(s):

Allison Carroll ◽

Anuj Kapilashrami

Keyword(s):

Public Health ◽

Unmet Need ◽

Public Health Facility ◽

Structural Factors ◽

Snowball Sampling ◽

Health Seeking ◽

Reproductive Choices ◽

Rural Tanzania ◽

Home Based ◽

Social Controls

ObjectivesAccess to reproductive information and contraception (RIC) continues to be a critical unmet need in Tanzania and impedes the realisation of reproductive health rights. This study examined key sources of RIC and the factors influencing their uptake by women in Mbeya region of Tanzania.SettingThis qualitative study was undertaken in a rural ward in a district in the south of the Mbeya regionParticipantsIn-depth interviews were undertaken with 48 women users and 2 nurses working in a public health facility, and focus group discussions with 16 home-based care workers in the district. Participants were recruited through a local non-governmental organisation (NGO) in the region, and via snowball sampling. All interactions were recorded, translated and transcribed and sought to identify the available resources and barriers in using them.ResultsParticipants reported six main sources of reproductive information and contraceptives: public health facilities, NGO mobile clinics, other women, Mganga wa Asili (witchdoctors/traditional doctors) and Duka la Dawa (pharmacy). Women users and healthcare workers identified a range of individual (age, marital status and geography) and health system-wide factors shaping women’s reproductive choices and preventing uptake of contraceptives. The study also revealed structural factors such as gender, ethnicity, indigeneity as key determinants of access and health seeking, placing women from Sukuma and Maasai communities is the most disadvantageous position. Historical social disadvantage, patriarchal social controls and the pressure to preserve sociocultural traditions that women experience in the Maasai and Sukuma tribes underpin their disconnect from mainstream services.ConclusionWomen’s reproductive choices and their uptake of contraceptives are shaped by the interaction of a range of individual, household, institutional and structural factors. An intersectional lens enables examination of the ways in which these factors interact and mutually constitute disadvantage and privilege.

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Burden of foodborne disease in the Netherlands: from science to policy

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.949 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

L Mughini Gras

Keyword(s):

Public Health ◽

The Netherlands ◽

Cost Of Illness ◽

Disease Burden ◽

Food Groups ◽

Source Attribution ◽

Productivity Losses ◽

Disability Adjusted Life ◽

Life Years ◽

Animal Contact

Abstract In the Netherlands, the Ministry of Health mandates the National Institute for Public Health and the Environment (RIVM) to provide annual updates of the number of illnesses, disease burden and cost-of-illness caused by an agreed-upon standard panel of 14 enteric pathogens. These pathogens are mainly transmitted by food, but also via direct contact with animals, environment-mediated and human-to-human transmission routes. The disease burden is expressed in DALYs (Disability Adjusted Life Years), a metric integrating morbidity and mortality into one unit. Furthermore, the cost-of-illness (COI) related to these 14 pathogens is estimated and expressed in euros. The COI estimates include healthcare costs, the costs for the patient and/or his family, such as travel expenses, as well as costs in other sectors, for example due to productivity losses. Moreover, using different approaches to source attribution, the estimated DALYs and associated COI estimates are attributed to five major transmission pathways (i.e. food, environment, direct animal contact, human-human transmission, and travel) and 11 food groups within the foodborne pathway itself. The most recent DALY and COI estimates referring to the year 2018 show that the 14 pathogens in question are cumulatively responsible for about 11,000 DALYs and €426 million costs for the Dutch population in 2018, with a share for foodborne transmission being estimated at 4,300 DALYs and €171 million costs, which is comparable to previous years. These estimates have been providing vital insights for policy making as to guide public health interventions and resource allocation for over two decades in the Netherlands. Herewith, the approach and outcomes of the burden of disease and COI estimates in the Netherlands will be presented, with a focus on how these estimates enable policy-makers and the scientific community to monitor trends, generate scientific hypotheses, and undertake public health actions.

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Determinants of COVID-19 preventive behaviours among adults with chronic diseases in the USA: an analysis of the nationally representative COVID-19 impact survey

BMJ Open ◽

10.1136/bmjopen-2020-044600 ◽

2021 ◽

Vol 11 (2) ◽

pp. e044600

Author(s):

Jessica Y. Islam ◽

Denise C. Vidot ◽

Marlene Camacho-Rivera

Keyword(s):

Chronic Diseases ◽

Rural Areas ◽

Prevalence Ratio ◽

Face Mask ◽

Chronic Obstructive ◽

Cross Sectional ◽

Obstructive Pulmonary Disease ◽

High School Degree ◽

The Usa ◽

Nationally Representative

BackgroundPreventive behaviours have been recommended to control the spread of SARS-CoV-2. Adults with chronic diseases (CDs) are at higher risk of COVID-19-related mortality compared to the general population. Our objective was to evaluate adherence to COVID-19 preventive behaviours among adults without CDs compared with those with CDs and identify determinants of non-adherence to COVID-19 preventive behaviours.Study designCross-sectional.Setting and participantsWe used data from the nationally representative COVID-19 Impact Survey (n=10 760) conducted in the USA.Primary measuresAdults with CDs were categorised based on a self-reported diagnosis of diabetes, high blood pressure, heart disease/heart attack/stroke, asthma, chronic obstructive pulmonary disease (COPD), bronchitis or emphysema, cystic fibrosis, liver disease, compromised immune system, or cancer (54%).ResultsCompared with adults without CDs, adults with CDs were more likely to adhere to preventive behaviours including wearing a face mask (χ2-p<0.001), social distancing (χ2-p<0.001), washing or sanitising hands (χ2-p<0.001), and avoiding some or all restaurants (χ2-p=0.002) and public or crowded places (χ2-p=0.001). Adults with a high school degree or below [Adjusted prevalence ratio (aPR):1.82, 95% Confidence interval (CI)1.04 to 3.17], household income <US$50 000 (aPR:2.03, 95% CI 1.34 to 2.72), uninsured (aPR:1.65, 95% CI1.09 to 2.52), employed (aPR:1.48, 95% CI 1.02 to 2.17), residing in rural areas (aPR:1.70, 95% CI 1.01 to 2.85) and without any CD (aPR:1.78, 95% CI 1.24 to 2.55) were more likely to not adhere to COVID-19 preventive behaviours.ConclusionAdults with CDs are more likely to adhere to recommended COVID-19 preventive behaviours. Public health messaging targeting specific demographic groups and geographic areas, such as adults without CD or adults living in rural areas, should be prioritised.

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Dementia Caregiving, Care Recipient Health, and Financial Burdens

Innovation in Aging ◽

10.1093/geroni/igaa057.183 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 56-56

Author(s):

Rashmita Basu

Keyword(s):

Physical Health ◽

Healthcare Costs ◽

Financial Burden ◽

Care Recipient ◽

Positive Feeling ◽

Nationally Representative ◽

Financial Burdens ◽

Health Deterioration ◽

Retirement Study

Abstract Objective: While about 75% of people with ADRD receive care informally by their family members, relatively little is known about the effect of the quality of caregiving on maintaining carerecipient’s health and financial burden of out-of-pocket (OOP) healthcare costs. The goal of this study is to examine the quality of caregiving on the out-of-pocket healthcare costs among ADRD patients and if caregiving prevents deterioration of physical health of carerecipients. Data and Sample: We used a nationally representative sample of people diagnosed with ADRD from the Aging Demographic and Memory Study, subsample of the Health and Retirement Study. The study sample includes carerecipients whose caregivers participated in the survey (N=261). Outcome measures: Primary outcomes were deterioration of carerecipients’ health (1=yes, 0=no) and annual OOP healthcare costs. The quality of caregiving is captured by if caregiving made them feel good, feel useful and fee closer to carerecipients. More than 70% caregivers reported that caregiving make them feel good or useful. About 60% of carerecipients’ physical health was maintained, and average out-of-pocket costs was $3,701/year ($0-$31,051). Multivariable logit for binary health outcome and OLS regression for OOP cost were estimated. Results: The likelihood of health deterioration was significantly lower for carerecipients whose caregivers reported that caregiving made them feel useful (AOR=5.1, 95% CI: 1.9- 14.5) and lower OOP remained significantly associated with presence of usefulness of caregiving (cost decrease, $3000 [95% CI: $6309-$918). Positive feeling of caregiving is independently associated with lower OOP cost and deterioration of physical health among ADRD patients.

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(A231) Deficiencies in the Preparedness of Emergency Medical Services Providers for Terrorist Incidents Involving Children

Prehospital and Disaster Medicine ◽

10.1017/s1049023x11002172 ◽

2011 ◽

Vol 26 (S1) ◽

pp. s63-s63

Author(s):

M. Reilly

Keyword(s):

Public Health ◽

United States ◽

Emergency Medical Services ◽

A Priori ◽

The United States ◽

Medical Services ◽

Special Populations ◽

Provider Education ◽

Emergency Medical ◽

Nationally Representative

IntroductionRecent studies have discussed major deficiencies in the preparedness of emergency medical services (EMS) providers to effectively respond to disasters, terrorism and other public health emergencies. Lack of funding, lack of national uniformity of systems and oversight, and lack of necessary education and training have all been cited as reasons for the inadequate emergency medical preparedness in the United States.MethodsA nationally representative sample of over 285,000 emergency medical technicians (EMTs) and Paramedics in the United States was surveyed to assess whether they had received training in pediatric considerations for blast and radiological incidents, as part of their initial provider education or in continuing medical education (CME) within the previous 24 months. Providers were also surveyed on their level of comfort in responding to and potentially treating pediatric victims of these events. Independent variables were entered into a multivariate model and those identified as statistically significant predictors of comfort were further analyzed.ResultsVery few variables in our model caused a statistically significant increase in comfort with events involving children in this sample. Pediatric considerations for blast or radiological events represented the lowest levels of comfort in all respondents. Greater than 70% of respondents reported no training as part of their initial provider education in considerations for pediatrics following blast events. Over 80% of respondents reported no training in considerations for pediatrics following events associated with radiation or radioactivity. 88% of respondents stated they were not comfortable with responding to or treating pediatric victims of a radiological incident.ConclusionsOut study validates our a priori hypothesis and several previous studies that suggest deficiencies in preparedness as they relate to special populations - specifically pediatrics. Increased education for EMS providers on the considerations of special populations during disasters and acts of terrorism, especially pediatrics, is essential in order to reduce pediatric-related morbidity and mortality following a disaster, act of terrorism or public health emergency.

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